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Trigger Finger: A Common Ailement In Premenstral Women, Diabetes And Patients With Other Metabolic Conditions
Miami May 15th, 2013- Trigger Finger (Stenosing Tenosynovitis) is a common musculoskeletal disorder characterized by the inflammation, snapping, catching and/ or locking of the involved finger. The descriptive name of “trigger finger” is used because when the finger unlocks, it pops back suddenly, as if releasing the trigger on a gun. Often painful, trigger finger is caused by a thickening of the tendon sheath (tenosynovial membrane) passing through a narrow anatomic tunnel (A1 pulley).
It's a life-threatening disease and topic of discussion that most men "sweep under the rugs." If they have it, they don't talk about it, and they don't bother to allow the doctor to perform the simple check to see if it's developing to catch it at the earliest stage so that it can be treated. When it comes to prostate cancer, most men adopt a don't ask, don't tell strategy. They see the disease as their "shame" because they view it as a threat to their "manhood."
"For a long time, associated with prostate cancer has been erectile dysfunction which means that the man either can't, or has problems performing with his wife on an [intimate] basis," says Valentine "Val" Maura, a member of US Too, a prostate cancer education and support group member. "Also, a lot of men don't get examined because they know they have to take a digital rectal exam (DRE), and when a doctor says you have to drop your pants, most men have all kinds of trepidation. Because of that examination, most men wait until it's kind of late."
Maura himself is one of those men who did not have his first prostate examination until late in life. His first check was performed at age 55. Doctors usually recommend that men without familial history have the exam performed for the first time at age 40, for the disease that occurs when cells in the prostate gland grow out of control. Most men have no early symptoms of prostate cancer, but some have urinary symptoms and discomfort.
"I wanted to know what my situation was and I was eager to find out what my condition was," says Maura of the first time he had his prostate examined. As soon as I got near the examination room I got a little chicken myself," said the 62-year-old. "I was real apprehensive when I found out what it entailed, but I said I had come that far and the only way I would find out my condition was to actually be examined."
Maura did the test and received a clean bill of health on his prostate. With his relief he said came questions and concerns as to whether the examination had been properly done and whether he was really safe. He has had his prostate checked every year since. Although he's not a survivor, he's one of those men willing to stand up and promote the awareness of this life-threatening disease most men shy away from speaking about, because they don't want people to know.
"I became interested in cancer some years ago, in the embryonic stage of the Cancer Society some years ago -- and I don't know if I have an inquiring mind, or a wavering mind -- but if I get involved in something, I like to know about it as much as possible. I don't like to just be a member."
As Us Too celebrates Prostate Cancer Awareness Month during September, and a decade as an organization, Maura says there is a lot more openness about the disease and the test to check for prostate cancer because men like himself and a few brave survivors have been talking about it, but he says there needs to be more talk among men. To encourage that much-needed chat, Us Too will stage its third 1,000-man walk for prostate health on Saturday, September 17 behind the theme "Man to Man, Hand to Hand, Foot to Foot, Mouth to Ear, Communicating Each Other's Prostate Concern." It's the Us Too organization's hope that as the men traverse the walk together they begin to talk together about the disease.
While more men talk about the prostate cancer today than they did 10 years ago, Maura says more communication is still needed about the disease that was once thought of as an old man's disease.
Prostate cancer screening statistics by Us Too over the last five years have for the most part increased during prostate screening clinics staged by the organization as the awareness improved. In 2003, their statistics show a total of 313 persons were tested. In 2004, the number dropped to 231, then again in 2005 to 227. In 2006, a total of 481 persons were tested during the clinics, with 373 presenting in 2007. In 2008, a record 771 tests were performed with 624 prostates checked in 2009, and last year, 687 men presented to have their prostates checked.
Statistics also show that most men reported that they took the test at the urging of their wives. In 2004, two men said their wives encouraged them to take the test. Last year statistics complied by Us Too show that 192 men said they had been encouraged to take the test by their spouses.
Maura says the information now suggests that men should have their prostate checked as early as 35, especially if they have a family history. He says prostate cancer is a disease that can be treated and men don't have to die from it if it's caught early enough.
"Men are worried about their manhood, but aren't doing much, or waiting too late to take the requisite steps to protect the very thing that could destroy their manhood," he says.
With several tests to detect prostate cancer the DRE is an early test to screen for the disease when it is most treatable. Maura say Us Too touts the DRE as it measures the degree of enlargement that a prostate has undergone and medical professionals are able to detect textural changes. A Prostate-Specific Antigen (PSA) Blood Test can be done in conjunction to the DRE.
"The PSA test alone won't be able to tell you what condition the prostate is in, because it has no way of measuring the degree of enlargement the prostate has undergone. There have been studies done that show that the PSA itself has no way of measuring what is happening to the prostate, so you could be falsely feeling safe or you could be way off the mark. The DRE measures the degree of enlargement the prostate has undergone and it has a certain texture that it develops because of the enlargement and so therefore you need both to tell you the true picture, because you can have an elevated PSA count, but it cannot tell you what is actually happening with the prostate itself."
Although not a prostate cancer survivor, Maura says checking your prostate is an overall health concern and that younger men who don't take care of their prostates now will suffer from it later.
"A lot of people think when you get prostate cancer it automatically progresses to stage four and you die, but that's not the case, there's a process where it becomes an embarrassment, it becomes painful, it becomes everything before you eventually die. Men tend to want to protect their manhood, but they're dealing with the very source of their manhood."
While there are no warning signs or symptoms of early prostate cancer, once a malignant tumor causes the prostate gland to swell significantly, or once cancer spreads beyond the prostate, men may have a frequent need to urinate, especially at night; difficulty starting or stopping a stream of urine; a weak or interrupted urinary stream; inability to urinate standing up; painful or burning sensation during urination or ejaculation or blood in their urine or semen. While not symptoms of the cancer itself, they are symptoms of the blockage from the cancer growth within the prostate and surrounding tissues.
Symptoms of advanced prostate cancer include dull, incessant deep pain or stiffness in the pelvis, lower back, ribs or upper thighs; arthritic pain in the bones of those areas. Loss of weight and appetite, fatigue nausea or vomiting, swelling of the lower extremities and weakness or paralysis in the lower limbs.
Maura says he knows of people who are undergoing prostate cancer treatment who have finally come to the realization that they are not going to die and that the disease is not fatal necessarily.
"They now find that because they're undergoing the treatment, they're looking at it much better. They still haven't been brave enough to speak about it in a public forum but they have at least come to grips with the fact that they don't have to die. Some are recovering from the surgery, some only have one or two more regimens of chemotherapy and radiation and are realizing it's a whole different ball game than the death knell they thought it was when they first found out."
Maura says too many men are worried about their manhood so they don't talk about prostate cancer, but he says not talking about it is the thing that could destroy their manhood.
During Prostate Cancer Awareness Month, Us Too will host prostate cancer screening clinics during the month on Tuesday, September 20 at the Elizabeth Estates Clinic, on Thursday, September 22 at the Flamingo Gardens Clinic, on Tuesday, September 27 at the South Beach Clinic and on Thursday, September 29 at the Fleming Street Clinic.
A frequent need to urinate, especially at night.
Difficulty starting or stopping a stream of urine.
A weak or interrupted urinary stream.
Inability to urinate standing up.
A painful or burning sensation during urination or ejaculation.
Blood in urine or semen.
These are not symptoms of the cancer itself. Instead, they are the symptoms of the blockage from the cancer growth within the prostate and surrounding tissues.
ADVANCED PROSTATE CANCER SYMPTOMS
Dull, incessant deep pain or stiffness in the pelvis, lower back, ribs, or upper thighs; arthritic pain in the bones of those areas.
Loss of weight and appetite, fatigue, nausea, or vomiting.
Swelling of the lower extremities.
Weakness or paralysis in the lower limbs.
WHEN TO SEEK MEDICAL CARE
Difficulty initiating and/or stopping a urine stream.
Pain on urination.
Pain on ejaculation.
Shaun Munnings is just 49 years old, but she's already had the photographs taken that she wants to be used for her obituary. After being diagnosed with lupus two years ago, she took the photographs because she says she knows that tomorrow is not promised to her.
"People get upset when I talk about death, but I tell them I'm not promised tomorrow, and with lupus, I could die this afternoon from the complications -- that's just how it is."
Munnings has suffered through misdiagnosis after misdiagnosis in her life, going as far back as her childhood when she said would indiscriminately break out in sores and swell up and would be treated for allergies. In her adult years, the trend pretty much continued -- misdiagnosis after misdiagnosis -- from spinal arthritis to one doctor telling her she needed to have surgery. And don't even think about the many different types of medications she's been prescribed over the years. When her mother died in 2007 it all came to a head.
"Everything pretty much went out of control because I was stressed out about my mother's death and grieving. I lost a lot of weight. I had rashes. I had sores in my mouth, and I was extremely tired...not the 'oh, I had a hard day' kind of tired; it was like, 'I can't move my body'. It was like my brain was telling my limbs to move, but it just wasn't working," said Munnings.
As in the past, she sought medical help.
"When the doctor asked me what part of me did I not feel pain, I said my eyelashes and my hair. Just to move to try to shift my body to get into a comfortable position, that was pure pain. Having the sheets touch me was pure pain. My body felt like it was on fire. I got to the point where I could not move and I was having pains in my chest like I was having a heart attack," she said. "I knew it wasn't a stroke because I felt the pain." Through it all she said the fatigue was extreme. "I was so tired that sometimes I would have to lift my legs to get into the tub and on a few occasions would end up being stuck in the tub because I could not get back out. My body wouldn't work for me to lift it over the tub."
After seeing too many doctors to count, Munnings finally found a medic who noticed the rash on her face and told her it looked like the malar rash also called the butterfly rash. It meant that Munnings could have lupus. After a battery of tests, Munnings was finally diagnosed in the latter part of 2011.
Lupus is a chronic inflammatory disease that occurs when the body's immune system attacks its own tissues and organs. It can be difficult to diagnose because its signs and symptoms often mimic those of other ailments. The most distinctive sign of lupus is the facial rash that resembles the wings of a butterfly unfolding across both cheeks. Some people are born with a tendency toward developing lupus, which could be triggered by infections, certain drugs or even sunlight. While there's no cure for lupus, treatments can help control symptoms. It's important to remember that no two cases are exactly alike.
Munnings said she felt relieved at finally being diagnosed correctly, especially after the frustration she felt when she knew something was wrong with her, but people kept telling her that it was all in her mind.
"I know lupus can be difficult to diagnose, but when you know something is wrong and people are telling you it's all in your mind, it can get frustrating," she said.
Having lupus she said also made her realize just how strong she is and what she can deal with. That's why she said she had the strength to have the pictures taken that she wants to use for her obituary. As for plans, that's the only one she says she can make, as she does not know how she will feel each hour or each day, so she makes no other plans.
"I can't plan ahead. If you want to invite me somewhere I can't tell you, 'yes I will be there', or 'I will not be there'. When I first started the medication after I was diagnosed, a week later I was like, 'yes, I'm back'. I'm a person who is used to doing things for myself...I like to work in my yard, and if anything needs to be fixed I'm going to try it myself, and if I can't do it then I call someone else. The medication was working very well for me and I felt like the old me, so I started cleaning the house from top to bottom. Cleaned the swimming pool, went swimming. Later on that night, I could not move. I [lay] in the bed and I cried. I called the doctor who said that I needed to remember that the woman I was, was gone."
It was after that that she realized she had to take each second and each hour at a time.
"Yes someone could walk outside and get struck by a bus, and their life is over. But with us, it's like, 'do I have the next second, do I have the next minute, do I have the next five minutes'."
She has a handicapped sticker for her car that allows her to park in handicapped parking spaces. When she started feeling good again, she removed it from the window of her car; the doctor told her to leave it up, because she may walk into a store but might not be able to leave without someone carrying her out.
"I just take one day at a time, and through prayer all things are possible," she said. "Right now I'm feeling good, but about two weeks ago I was like, 'Oh, Lord I'm ready to meet you'. When I first started out, I told the doctor...you know what it is for a person who knows that she serves a happy God to be praying to him -- the God of life -- to die."
The mother of a 23-year-old son said that while she may only have been diagnosed in the last two years, when doctors went back through her medical history, they noticed that she showed lupus traits during her pregnancy, going as far back as her childhood sickliness that left everyone wondering what was wrong with her.
Munnings, who works in accounting, said her employer has been understanding of her struggles over the years and has worked with her. When she can't get into the office, they allow her to call in from home.
Even though she has insurance through work, she says lupus has also hit her hard in the pockets. She has to spend at least $600 per month out of pocket for medications and doctor's visits.
Munnings who is a member of Lupus Bahamas 242 also credits the group with helping her to get through.
"What people don't realize is that while we try to keep ourselves on a happy note, we still have the reality of lupus looming over us. I love the members of the group because you realize even though lupus treats everyone differently, at some point we've all gone through the same thing. So it's like, 'How did you go through this', and it's truly a support group, because you can go there feeling in pain, but when you leave, you still have the pain, but you're laughing."
The month of May is recognized around the world as Lupus Awareness Month, and Nassau-based support group Lupus 242 is leading the way in the education about the debilitating disease that affects an estimated 5.5 million people globally. There are no real statistics on the number of people in The Bahamas with lupus. Lupus 242 to date has 50 active members.
Karl McCartney is crafting an excellent career in the Canadian Football League (CFL). Drafted 37th overall, in the fifth round of the CFL Draft of 2010, McCartney signed with the Calgary Stampeders and is carrying on as a Bahamian presence in place of Godfrey Ellis who played his last season with the Stampeders in 2009.
McCartney, as did Ellis, has to make do with competing in the shadow of the higher profiled leagues in the United States, the National Football League (NFL), in particular. Nevertheless, he is determined to do his best to heighten the status of the CFL. He is quite dependable as a linebacker and special teams performer and is proud of his career highlights to date. McCartney played with the rest of his teammates in the 2012 Grey Cup and he considers that a special milestone despite the defeat at the hands of the opposing Toronto Argonauts.
McCartney began to demonstrate his true abilities afield in his rookie season as a special teams standout. He led the team with 19 special teams tackles. In 2012, he was the CFL's No. 3 player in special teams tackles (23). He played 17 regular season games in 2010, seven in 2011, and 18 in 2012, plus the playoff contests.
What's going on in 2013 for McCartney? This is an update he gave me recently:
"The Calgary Stampeders have the best record in the CFL (31-3 as of October 25). I was having a great season (but) then I broke my hand after Week Six. I had surgery and now I'm back in the line-up."
He is the modest one but has high hopes for another trip to the Grey Cup Championship game. McCartney knows he needs to keep getting those opportunities in order to be successful in matching Ellis who was with the team in 2008 when the Stampeders won their last Grey Cup.
McCartney is conscious of the global sports stage and strives for his "special" place in Bahamian sports history. A Grey Cup Championship would put him directly in the company of the Bahamian forerunner on the Stampeders, Ellis. Ever cognizant of playing a bit under the radar in the CFL, McCartney acknowledges being that more determined to make his fellow Bahamians proud by attaining milestones that enhance the country's sports image.
In an earlier interview, McCartney talked about how important it was for him to be representing his country.
"It's about team play in the CFL and not a national team that competes in international events, but it's still about representing my country," he emphasized.
In truth, he runs onto the field in the uniform of the Calgary Stampeders, but it is also as a player born in Nassau, from the Commonwealth of The Bahamas. Just 26, barring career-hampering injuries, McCartney should be around for about another five years and put up numbers that every Bahamian would appreciate.
Continued best wishes Karl!
(To respond to this column, kindly contact Fred Sturrup at firstname.lastname@example.org)
If he'd had a choice between contracting the Human Immunodeficiency Virus (HIV) or developing kidney failure, Marcellus Miller, an eight-year dialysis patient said having the HIV virus would be a much more attractive option. This may sound alarming, but the 38-year-old believes that life with HIV is much better because he believes it at least offers a quality of life that kidney failure does not.
Miller said many people do not fully understand to what extent being on dialysis indefinitely means and that it more or less ends your life.
"No matter what you do or how healthy you may try to be, being on dialysis will take its toll and your life is definitely in limbo. On the other hand [with] HIV/AIDS, although there is a stigma attached to it and it has its downfalls, it doesn't stop life if you take care of yourself. You at least have a greater chance of living a normal and unhindered life as long as you stay on the recommended medication and remain healthy. On dialysis you are not so lucky. You can do everything to the moon and back and you can still just die due to complications or with no warning at all."
Knowing that his heart could fail, or that he could go from feeling great to awful in a split second is a scary prospect that he has to live with daily.
It took him a long time to come to terms with the many lifestyle changes he had to endure due to having kidney failure and being forced to use a hemodialysis machine to have his blood cleaned.
Developing kidney failure was not a surprise to Miller. Because he was diagnosed with type 1 diabetes at the age of seven, he grew up knowing that he would probably have to face issues like an enlarged heart, blindness or kidney failure one day.
"My doctors actually were surprised at how long it took to happen since I was about 30-years-old when my kidneys just gave out. So I knew it would come and I would just have to make changes but how much it would affect my life never really hit me until it happened."
When it happened though, he was still not mentally prepared. Adjusting to dialysis and his new life was hard for him. He described it as traumatizing. The young man who had always been on the go, continued his world travels for a year after his diagnosis as he attempted to continue with his normal.
"At first, I missed out on a lot of dialysis sessions. I still traveled as usual and would attempt to do dialysis in another country when I could. I don't think I paid attention to my diet as well as I should've at first either. It was such a big adjustment for me. It took me getting tired of feeling deathly sick, and spending so much money to do dialysis in another country for me to just say that I had enough. I knew I had to slow down and fully grasp what was happening to me after a while."
He started to take care of his health and tried to do what he knew was best. He watched his diet, and committed himself to his four-hour long three-days per week dialysis treatments at the Princess Margaret Hospital.
No joking matter
Kidney failure is nothing to joke about and why people should pay attention to their health, said nephrologist Dr. Ronald Knowles. He said most kidney failure can be prevented, or at least put off until much later in life, but that many people do not take it seriously until it is too late in most cases.
"Most people are under the misconception that kidneys only do one thing - filter toxins from the blood, but this is not so. Kidneys actually are essential for three main things in the body. They remove toxins that accumulate in the blood. They regulate the body's water content which is important because without it you can bloat excessively, [and] they also work to control blood pressure and certain mineral levels within the body like sodium, potassium and calcium. Without these organs (kidneys) a person is prone to further health problems and death."
Most people attribute kidney damage and failure to not drinking enough water on a daily basis. Although the lack of fluid intake is a contributing factor, the leading causes of kidney failure are uncontrolled high blood pressure and diabetes, according to the doctor. And these two chronic conditions are responsible for at least 80 percent of the kidney damage and failure in Bahamians.
"Diabetes and hypertension are two conditions popular in our country and this wouldn't be so bad if people did what they had to do to regulate them, but they don't for the most part. This is why we have so many people who are suffering from kidney failure."
The medical professional urged people to remain vigilant about their health.
"If you are monitoring your blood pressure, it should be less than 135/85. A controlled blood sugar level is less than seven percent when a [hemoglobin A1c] test is done. A regular urine analysis is not enough anymore because it's not the most accurate in determining blood sugar levels. I think it is important to do things the best way you can so you know what just what is going on in your body."
Eat your fruits and vegetables
To ensure one's kidneys are in the best health, eating fruits and vegetables regularly is key. Cutting back on salts and eliminating fast foods as much as possible is also important. Also, keeping up with exercising, drinking adequate water daily and doing an annual physical is a good addition to your health regimen.
Even if you do all of that, there are still some people who will develop kidney damage and eventually failure, said the doctor. In those cases, he said it's usually an inherited defect or due to other health related problems that overtax the kidneys and shut them down. No matter how someone developed kidney failure, Dr. Knowles said there are ways to deal with the problem and that someone with kidney failure does not have to feel like their life is over and that they have to give up everything.
There are three main options for people with kidney failure - a kidney transplant, hemodialysis and peritoneal dialysis.
The best treatment is always a kidney transplant, said Dr. Knowles, but transplants are usually hard to get if a patient does not have a relative who is compatible and willing to give a kidney.
Hemodialysis, the form of treatment most people are familiar with is a good option to use until a transplant can be performed. Hemodialysis requires patients to visit a clinic three times a week for four hours each time in order to cleanse the blood of toxins by using a dialysis machine. The third option, peritoneal dialysis, is a good way to go for patients requiring more freedom and not minding a more hands-on experience with their dialysis treatments. It is a personal dialysis procedure in which the patient undergoes a minor surgery to insert a catheter or permanent tube in the stomach. This allows fluids to be introduced into the stomach and then toxins like urea and excess glucose from the body diffuse across the peritoneum - a layer in abdomen - to be drained out later. The process usually needs to happen three or more times a day. The doctor said this option is good for people with busy lives who don't have the time to visit a medical facility three times a week. It does have a downside because people with the catheter are likely to get infections at least once a year because of it.
"While there are ways to deal with this problem (kidney failure), people do have a higher likelihood to live shortened lives. This is due to other health related problems that arise due to their kidney disease and failure. Most people with kidney failure tend to die from heart disease later on and it happens so quickly it is unexpected," said the nephrologist.
"But if one is healthy and their own ailment is kidney problems, they have a possibility of living 20-plus years after commencing treatment and staying healthy. The reason other people can die a week or months into treatment is usually due to other ongoing problems like poorly regulated diabetes, hypertension, pre-existing heart conditions or other chronic ailments. Having kidney disease and doing dialysis only adds to the strain on the body and this can eventually lead to early death in the long run. Even so, I encourage all persons to just stay positive and be as healthy as possible. Kidney disease is only one of the many problems that exist due to poor health, so this is not the only problem to look out for," said the doctor.
Not an easy road
Miller said dealing with his kidney failure and dialysis has not been easy and that he misses many of the things he used to do, but that he's happy he is doing better and that he's actually now doing what is right.
"Having something like kidney failure really makes you see things in a new light. You realize what is most important from what isn't. I have definitely grown closer to God and just learned to laugh at life and myself a lot more. It's not an easy road but it is one that you have to make the best of," he said.
He encouraged people who have to undergo dialysis to find support in family members and in other people who are going through the same thing.
"If there was one lesson I have learned in doing dialysis is that you have to keep positive and do all that you can to keep busy. You can't think about yourself anymore and sometimes the only way to get through life at this point is to laugh and just enjoy the small things. I have grown a great sense of humor and a sense of giving that I never had before. To me it's important to just keep on going no matter what."
After eight years of dialysis treatments and sporadic visits to the hospital's emergency room, a ray of hope is being shed on Miller's life. A kidney match has been found for him and he's scheduled for a 2015 transplant. He said it's the best thing he could imagine happening to him and that he was looking forward to living a better quality life in years to come.
It seems as though Bahamian professional football player Devard Darling can't 'catch a break' in the National Football League (NFL). Just when he thought his career was taking off again on the gridiron a knee injury put the wide receiver on the sidelines.
Determined to play this year, Darling settled with the Houston Texans who had picked him up earlier this summer, instead of being placed on the injured reserve list, which would have ended his season. Now, he is a free agent again. Darling tore the lateral meniscus in his right knee during the third pre-season game against the San Francisco 49ers. He underwent surgery on August 30.
"About two and half, three weeks ago, I got cleared from all the doctors, so I am all cleared, fully healthy and ready to go again," said Darling. "I have my agent working for me, but we still don't know anything yet. We are waiting week to week to see who has a need for a receiver, so that is the biggest thing right now. Unfortunately, in this business, a man's loss is another man's gain, so if someone gets hurt during the season that is where they will bring in another receiver. Right now, I am just waiting. You never know, this is just the way the game goes. Once I get that call I am ready to go, so we will see. It is all in the Lord's hands right now."
Darling said he is not 'antsy', despite the fact that the NFL is heading into Week Six of the 2011/2012 regular season. He is confident that the wait is not in vain, and that the important phone call is going to come. Right now playing on any of the 32 registered teams in the league will suffice, but if he is given a choice, the lean is more to the Texans.
He added: "Of course I am really leaning with the Houston Texans because I was with them in training camp. I know their plays, and also I am already in Houston. I can't sign back with the team until Week 10 because that is the NFL rules. They put me on IR (Injury Reserve) and I got a settlement from that, and I was released of injury reserve. I can't sign back with them until six weeks after I am fully recovered from my injury, so that is what it is right now. I can sign on with anyone right now because I am healthy and I am a free agent."
Darling signed on with the Texans in August of this year. He made his return to the NFL after playing in the United Football League (UFL) with the Omaha Nighthawks. The wide receiver was drafted into the NFL in 2004, the 87th pick of the Baltimore Ravens in the third round. He spent three years with the team, catching 20 passes for 331 yards and three touchdowns.
Darling then moved on to the Kansas City Chiefs in 2008 where he played in their camp for one year until he joined the Nighthawks in 2010. This is second sport-related injury since his official debut on the professional ranks. The first occurred while in the Chiefs' camp.
He doesn't believe that his career is over, and brushed his mishaps off as "a part of the game."
"This is a profession that I was blessed with and chose to do," he said. "This is just the business side of it, so you just have to go out there and work hard everyday, continue to hone your skills as much as possible on the field. All I can do right now is sit back and wait on that call. All I am doing is praying and waiting on the Lord to move on my behalf.
"I am training. I am training everyday. I just got done with a good workout so now I am icing. I have been training here in this facility called the Flex in Houston. A bunch of other football players are here and NFL veterans working out. They are basically in the same situation that I am in, a free agent, so it is good to workout and be around other guys, running routes, catching balls and getting ready."
Darling thanked all for supporting him during this rough time. Special thanks were sent to those who sent words of encouragement, especially from Bahamians wanting to see him back on the field.
Dr. Krista Nottage Is Top Award Winner
No one ever thinks they will develop cancer. Cassandra Lewis-Moore was one of those people. The 34-year-old thought there was a possibility she would get diabetes as it'runs'in her family, but she never thought cancer would happen to her. But during the eighth month of pregnancy with her first child in October 2010, she felt a huge lump in one of her breasts. She knew something was wrong. She sought medical attention.
"It was very large, and it shouldn't have been there,"recalled Lewis-Moore."I'd never felt anything like that before. It didn't hurt, but it was very hard and very big. But because the breasts were so large you couldn't see it."
Because she was pregnant, her doctor ordered an ultrasound of the breast and concluded it was breast milk that would go away once she started breastfeeding. Lewis-Moore, a newlywed and her husband, Kevin welcomed a beautiful baby boy, Andreus, who they call"KJ"into the family. In the months after her son's birth, she noticed her breast size decreasing, but the lump getting bigger and protruding through the skin and not disappearing like the doctor had told her it would. It had started to hurt. It was a pain she chalked up to tenderness from breastfeeding. That was until the day she was playing with a then crawling"KJ"and like all babies do, he kneed her in the breast. The pain was excruciating. She remembers actually pushing her baby away from her so suddenly that she scared him. She thought about what the doctors had told her, and massaged her breast and put hot towels on it to help dissolve the milk. But it was the day that she took a"me day"in January 2011, and headed to the spa for a massage. As the therapist worked on her back, she said it was so painful she could not complete the therapy. That pain sent her back to her doctor.
Her doctor requested a mammogram. The result showed hardened milk. Her doctor requested a lumpectomy to remove the hardened mass, which was done in March 2011. The mass was tested and the result returned as Stage 2 breast cancer. The cancer cells were actually inside the hardened breast milk.
FRIGHT TAKES HOLD
Lewis-Moore was scared--not because it had taken so long to determine she had breast cancer--she was mad because she wondered what would happen to her family after she'd waited so long to get married and have a child, and then to be diagnosed with cancer while still a newlywed and a new mother.
"In my 20s, it was all about education and my career--so in my 30s, it was about getting married. And I'm the only girl and the last child in my family, so it was a big thing[for me to get married and have a child], and to be told this[that I had cancer]. I thought, what was going to happen to my family?"
Lewis-Moore began her battle with the deadly cancer cells. She celebrated her baby's first birthday one week before she began chemotherapy treatment. And she did her best to keep her energy up over the months of treatment for her child, who was too young to understand that his mom was sick.
"He just knows one day mommy had hair that he used to pull,"says Lewis-Moore who boldly sports a bald head no hair caps for her."The tough part was when we were playing one day and I had already started chemo, and he pulled on my hair, and a whole clump came out in his hand and fell on his face. He just dropped it and ran. He was scared. But other than that, mommy is still mommy. Sometimes, she can still play; sometimes, she can't because she's very tired."
She's finished with chemo, but will have to take additional treatment because she was diagnosed as HER2-positive. This is a diagnosis for people who have a protein called human epidermal growth factor that promotes the growth of cancer cells. HER2-positivebreast cancers tend to be more aggressive than other types of breast cancer. They're also less responsive to hormone treatment. However, treatments that specifically target HER2 are very effective.
"I'm going to have to do additional treatments, but they're not as severe as the chemo, and they want me to do radiation, and we're still setting that up."
The road to survivor isn't quite finished yet, but Lewis-Moore begs to differ. "I had a lump--the cancer was there, and they took the lump out, and the cancer hadn't spread."
Even though chemo was a downside, Lewis-Moore has come out on the other side with a friend--a 31-year-old who had to have an immediate double mastectomy because her cancer was spreading like wildfire.
"Chemo was rough; I will not lie,"she says."It is not rough for everyone, but for those who have the illnesses after the chemo, make sure you have a strong support system at home and at work."
BRINGING SEXY BACK
She is now on a slow road to bringing sexy back. She's walking at least 20 minutes a day as recommended by her doctor, and looking forward to the fabulous new breasts she will soon be getting. She had a partial mastectomy on one breast, but to put safety measures in place for her future, she wants to have a double mastectomy then get those"fabulous new breasts"with which will come a tummy tuck. The surgery she will have done, a TRAM Flap Breast Reconstruction, which is the gold standard in breast construction, removes some of her stomach skin and fat, to reconstruct her breasts and fill them in.
As she battled the disease, she admits that she was not always as confident as she is today and says at one point, she really stopped trying and didn't bother with anything. But after a month or two, she said to hell with it--that she was going to live her life and have fun. She was going to dress up and go out and rock her bald head.
When she first started to lose her hair, which was natural, her cousin took her to his barber and she got a low haircut. The hair continued to come out, so she told her husband to shave off the rest. Right after she did that, Lewis-Moore, who works for BAF Financial and Insurance Bahamas Ltd., the coordinators behind Denim Day in the country for 14 years in raising monies for a cure, says she had to attend a company awards ceremony to which she wore a head-wrap. For a week she wore different head-wraps until she was hit by a hot flash at work. All she wanted to do was get naked, but she couldn't at work. The best thing for her to do was remove the head-wrap. That was the last day she wore one.
Removing the head-wrap liberated her and gave her confidence.
"I had another coworker who had breast cancer and her advice to me was to just wear makeup, but I couldn't wear that because I sweat too much, so I would just draw on my eyebrows if I remembered in the mornings. One morning, I woke up, was washing my face, looked in the mirror and said,"By damn, I don't have any eyebrows, eyelashes, nothing. So some days, I had eyebrowsâEUR¦some days, I didn't and I put on my lip-gloss, put on my earrings and was out the door."
The cancer survivor is excited for her future. And she says cancer does not have to be a death sentence. She says women need to take their health seriously and check things out because they know their bodies, and know when something is wrong. She encourages them to get bumps or moles that they hadn't seen before checked out.
For anyone who has been newly diagnosed with breast cancer or will be diagnosed in the future, Lewis-Moore says she has learned that you need to have a strong support system at home and at work, both of which she had.
Through her battle, Lewis-Moore was thankful for the support she received from her husband, and also thankful that he had a group of friends with wives, sisters or mothers that had breast cancer that he could talk to.
"It was tough, because being a newlywed and fairly young, and I didn't have urges. It just wasn't there. I was miserable in the sense that I did not want to be bothered and I did not want to be here."
But she says her husband's support, as well as that of her family--her mother traveled from Grand Bahama to stay with them for six months--and her aunts and cousins helped by keeping the baby some days and make certain she was okay, especially after days when she endured eight-hour chemotherapy sessions, helped her through the rough times. And her co-workers that knew what she was going through were helpful and very understanding.
"I never thought cancer would happen to me. I thought maybe I would get diabetes because that runs in my family, but never anything like this,"she says.
Colin Callender, QC, is a top lawyer whose career has spanned five decades. Considered one of The Bahamas' leading experts in insolvency, Callender has worked side-by-side with major corporations and banks both domestically and abroad. He is the managing partner of the country's oldest law firm, Callenders & Co., and was recently elected as a director of the International Academy of Trial Lawyers. Callendar is also the chairman of the board of The Nassau Guardian.
Guardian Business: What is the biggest challenge facing your business or sector? What measures need to be taken in The Bahamas to solve it?
Colin: In the past few decades professionals and other individuals in commerce in general have experienced the radical changes in the way business is now conducted globally. The challenges facing those of us in the legal profession are the expectations from the public as to the time frame within which we are expected to respond, either to e-mails or other instant means of communication, and to provide opinions on oft times lengthy and complex documents or advice in matters without permitting a reasonable time to carry out diligent and responsible research. This pressure has forced some professionals to outsource some of this work which may, in the pure interest of time, compromise its quality.
There is now an accepted rule with respect to the authenticity of documents generated electronically including signatures on documents. With very few exceptions, an original signature is required in the case of, for example, a document relating to title (i.e. a deed of conveyance).
Technology in The Bahamas has kept pace with the developments worldwide and can only function properly and effectively if those faced with it apply themselves with conscious and dedicated determination to be responsive as quickly as possible or as the system dictates. It is a mind set and a new culture that has proven to be difficult to instill in some members of our business community; adapting to this new business environment is essential if we are to remain competitive in the world arena. In my profession the ability to access online, for example, law reports in those common law jurisdictions which post their decisions online, to access the Statute Laws of The Bahamas, access to the Companies Registry as well as the Registry of Records are all major steps which have been taken to bring The Bahamas to the forefront and in line with the ever changing global technology. More needs to be done and can be done towards the introduction of e-communication in the court process such as the ability to file pleadings in court cases online.
GB: How has your business or sector changed since the financial crisis?
Colin: The financial crisis has influenced the way business is conducted today. We have all become much more conscious of the way we utilize our time while continuing to strive to provide better service for our time. With the implementation of improved communications, the ability to conduct meetings via video conferencing has eliminated the necessity in many cases for time consuming and expensive travel and accommodation for those international business meetings. Competition has increased immeasurably in almost every area and discerning clients are insisting on value for money.
GB: Can you describe an experience that has changed your approach to life?
Colin: It's been said that what doesn't kill you makes you stronger. It also made me wiser. In 1993, I was diagnosed with prostate cancer. Until you hear the words, you cannot fathom the emotion and fear that course through your body in waves, thoughts that drown out everything else. I opted for surgery. God and time were on my side and I had a fairly optimistic prognosis.
I returned to my practice but found my priorities had changed. I continued to work hard but I made a "bucket list" of the things I really wanted to do. For years, I had dreamed of designing and building the perfect fishing boat, one that would also be comfortable for my family. My wife and I threw ourselves into the ambitious project and two years later our dream boat was reality.
Life was good. I was working hard while also making time to enjoy my golden years when in early 2002, I got very bad news. The cancer had re-appeared. Determined to beat it one more time, I commuted to Florida daily for eight weeks for radiation treatments, taking the early morning flight and getting back to the office by mid-day. Every day, I told myself I will survive! With the encouragement of my family and the success of the treatments, I did. And a decade later, I give thanks every day for good health.
Then, when my health and I seemed to be at peace with each other, totally unpredictable events happened in my law practice, the end result being that the make-up of the firm changed substantially over a few years. I believed that if I had beaten cancer twice I could survive the changes in the firm and I am extremely pleased to say that with the strength that I found - in part from the resolve I found from fighting cancer and in part from my present partners - we have rebuilt Callenders & Co, creating the strongest legal and support teams we have ever had in our 109-year history. I continue to work at our two offices in Nassau, Millars Ct. and Lyford Cay, every day, but I know that spending time with my family and friends is essential to my well-being and happiness. It was a very tough way to learn a lesson but I discovered that you never know the real power of your own inner strength until you are called on to reach down deep inside, find it, trust it and use it.
GB: What keeps you grounded? Do you have any major interests other than work?
Colin: What keeps me grounded is the discipline and the values which were instilled in me from an early age, from my parents and grandparents and more importantly the ability to spend time with my wife and family and the enjoyment of sharing experiences with them. Too often one sees friends and colleagues who are not able to "switch off" from the office and enjoy family and friends. Major interests which I have enjoyed outside of work, have been sailing, diving, traveling to exotic destinations and the promotion of organizations whose goals are the preservation of the environment.
GB: What should young businesses keep in mind in this current economic climate to survive?
Colin: Young people going into business must approach it with a well prepared business plan which takes into account the available resources to ensure that the business is not under capitalized from the outset. Key to success is the recognition that only hard work and dedication will determine the attainment of ones goals and not an expectation of immediate reward which is too often the case nowadays. Additionally, quality service is extremely critical for the success of any business in today's economic environment.
GB: What makes a great boss? What makes a bad boss?
Colin: I'd like to start with answering what makes a bad boss so we can end with a positive reply in what makes a great boss.
A bad boss is one who lacks good communication skills, lacks respect for his staff and expects more of them than is realistic. A bad boss fails to recognize individual strengths and weaknesses, thus treating every member of staff as if they were all supposed to come equipped with the same work DNA. A bad boss is quick to dish out criticism and slow to hand out praise.
A great boss is exactly the opposite. In addition to first and foremost being well-informed and knowledgeable in his field, a great boss exemplifies a work ethic expected of his employees. He is one who empathizes with his employees and makes himself available to them when problems arise whether it is on the job or sometimes on a more personal level. Leadership and communication is first and foremost and I will not ask any employee to carry out a task that I would not undertake myself. I cannot overstate the example of a solid, tireless work ethic being exhibited by the "great boss".
Secondly, I am a strong believer in personal recognition. I believe a good boss truly respects and rewards those whose ideas are worthy, work ethic is admirable and loyalty is never in doubt. We have fallen into the unfortunate habit of thinking that the word reward automatically means financial when in fact real professionals appreciate other forms of reward. Firm or company recognition, special honors, travel and appointment opportunities and advancement are strong motivators. A great boss knows that there is no such thing as too much appreciation of a staff member who makes a difference.